Women: You Have Alternatives to Hysterectomy

Despite publicity about its overuse during the last two decades, hysterectomy — followed by cesarians — is the most common operation performed on American women. By age 60, more than one-third of all women will have had one. First performed 1,900 years ago in Roman times, a hysterectomy involves the removal of the uterus, cervix, fallopian tubes and ovaries. Sometimes ovaries or the cervix, are left intact. Incisions are made through the abdomen or the vagina. While hysterectomy can remove fibroids and eliminate worries of future disease in the uterus, recovery time is sometimes up to two months and some women complain of an impact on their bladders, bowels and sex life.

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A Common Treatment for Fibroids

Most hysterectomies — nearly 40 percent — are for fibroids, which trouble at least 25 percent of all women at some point in their lives, usually between ages 30 and 40. These usually benign tumors often cause heavy bleeding in pre-menopausal years. They can also contribute to pelvic pain, lower back pain, constipation, frequent urination, bladder pressure, pain during sexual intercourse, and, depending on location, infertility and premature birth.

Women also have hysterectomies for unexplained pelvic pain, the "prolapse," or dipping down, of the uterus into the vaginal canal, and endometriosis — stray bits of uterine tissue growing in the wrong places.

Alternatives to Hysterectomy

While many women have no problem with having a hysterectomy — others wish they'd known about their alternatives sooner. "There are a whole new array of interventions women should at least know about," said Gaylene Pron, a University of Toronto epidemiologist. If symptoms develop, Pron explained, women can try drug therapy, including non-steroidal anti-inflammatory drugs and birth control pills and procedures that remove the fibroids (not the entire uterus) and block blood supply to the fibroids.

"The fact is, there are a number of alternatives for hysterectomy that either because of established routine, past training, or stubborn schools of thought within gynecology, haven't been given their due," said Dr. James Spies, a Georgetown University specialist in treating fibroids.

Myomectomy

In October 2000, Ryan opted for a myomectomy — an outpatient procedure in which fibroids are removed via an instrument inserted through the abdomen or vagina. Myomectomy successfully controls symptoms in about 80% of all cases without removing the entire uterus, but it can cause uterine scarring and isn't failsafe; one in 10 women need further procedures because the fibroids grow back.

The American College of Obstetrics and Gynecology concluded in May 2000 that while myomectomy generally provides "excellent resolution of symptoms" research on the subject was "poor" and had rarely been compared with hysterectomy in rigorous studies. For Ryan, it "was the greatest thing I've ever done," said Ryan. "I kept all my organs and I'm pain free — and without some of the physical problems women have with hysterectomies, from bladder to hormone problems."